International Orthopaedics (SICOT) (2010) 34:607

DOI 10.1007/s00264-009-0947-2

LETTER TO THE EDITOR

Comment on Singh et al.: Fractures of capitellum: a review

of 14 cases treated by open reduction and internal fixation
with Herbert screws
Anil Agarwal

Received: 8 December 2009 / Accepted: 23 December 2009 / Published online: 2 February 2010
# Springer-Verlag 2010

We read with deep interest the article by Singh et al. [1].

We thank the authors for sharing with us such experience
with these rare injuries.
Since the capitellum injury is an uncommon fracture, the
described technique left certain queries unanswered for the
less experienced user. Do the authors routinely recommend
CT in all capitellum fractures as assessment of fracture
comminution by plain radiographs is particularly deceptive
in this region [2]? Again, how long did the fractures take to
unite and how was the union assessed radiologically? Singh
et al. recommend very early mobilisation (e.g. illustrative
case 2) of elbow joint even in bone grafted cases, which is
not a common clinical practice, unless the graft itself is
stabilised. Moreover, the fracture fragments are often
osteoporotic in old fractures, precluding stable fixation, and
the risk of implant cutting through remains high with such
early mobilisation. Singh et al. also managed three capitel-

A. Agarwal
Department of Paediatric Orthopaedics, CNBC,
Geeta Colony,
Delhi, India
A. Agarwal (*)
4/103, East End Apartments, Mayur Vihar Ph-I Ext,
Delhi 110096, India
e-mail: rachna_anila@yahoo.co.in

lum fractures which were more than six months old. An

older epiphyseal fracture usually presents with hypertrophy
of articular cartilage, rounding of margins and sometimes it
is practically impossible to make out the proximal fractured
surface of the fragment. Despite a meticulous surgical
technique, restoration of joint congruity is difficult. Did
Singh et al. face such difficulties in their series?

References
1. Singh AP, Singh AP, Vaishya R, Jain A, Gulati D (2009) Fractures
of capitellum: a review of 14 cases treated by open reduction and
internal fixation with Herbert screws. Int Orthop. doi:10.1007/
s00264-009-0896-9
2. Mahirogullari M, Kiral A, Solakoglu C, Pehlivan O, Akmaz I,
Rodop O (2006) Treatment of fractures of the humeral capitellum
using Herbert screws. J Hand Surg Br 31:320325